The Virtual Doctors medical director Dr Daniel Grace on delivering telemedicine to Zambia during Covid
The Virtual Doctors is a UK-based NGO, which uses a bespoke telemedicine app to connect isolated rural health centres in Zambia with volunteer doctors, based in the UK and Zambia.
The UK has one doctor for every 360 people, whereas Zambia has one per 12,000 people. Clinical officers (COs) at rural health centres may see 60 to 100 patients a day, and will treat both adults and children, as well as managing dental problems, obstetrics and trauma.
We have partnered with the Zambian Ministry of Health for more than 10 years, and now have over 200 volunteer doctors, offering text-based diagnostic and treatment advice in a range of specialties.
I’ve been the charity’s volunteer medical director since the start of 2020. I got involved because I wanted to volunteer in a sustainable way, while continuing to work as a GP.
I check my emails before work, and am pleased to see new volunteer requests. Despite the pandemic, we saw a 70% increase in volunteer numbers in 2020. I put this down to two things: first, the pandemic has shrunk the world and we’re now used to interacting online: second, Covid has shed new light on huge health inequities around the world.
Two GPs, an infectious disease specialist and a paediatrician, have got in touch today. I send them an application form. We have almost every specialty on board, but are always keen for more.
Today I’m giving a Zoom talk to students at the University of Plymouth. For the past six months, we’ve had a group of students from Keele Medical School who help run our service. We’ve also just had medical students from Oxford and Cambridge in their virtual medical electives, a sign that the next generation of doctors is acutely aware of global health.
After a day of remote triage work with the UK-based Covid Clinical Assessment Service, it’s time to answer a case referred from a Government-run health centre in Kalomo, Southern Province.
The case concerns a 26-year-old with chest tightness, cough and joint pains. The CO has checked his vital signs, which are normal, and also done a malaria test, which is negative. I write a reply, conscious that this may be Covid, and also aware of their limited resources. I emphasise the need to check for a history of fever and, if possible, to check his O2 levels. Zambia also has significant HIV and TB problems. I ask the CO to get an up-to-date HIV test from this man, and to perform a gene-expert test on his sputum for TB.
It’s time for my weekly meeting with the charity’s CEO Mr Huw Jones. We discuss the Covid situation in Zambia and the challenges faced by clinics. Basic things like access to clean water weren’t always available at the start of the crisis. We launched our ‘Clean Water for Clinics’ initiative in April 2020, to provide foot-operated handwashing stations. There’s a rumour that the President of Zambia used one recently when visiting one of the clinics.
We discuss how we can support our volunteers, who respond to around 255 cases a month. I suggest an online conference so they can meet virtually. They’re scattered throughout the UK, and it was great to have our first Zoom conference earlier this year.
After a morning’s phone triage, I attend another virtual meeting with charity board members to discuss funding. This is important, as we don’t receive any government support. Recently, with changes to the Foreign, Commonwealth and Development Office, and cuts in the UK’s aid budget, grants have vanished. Combined with Covid’s impact on mass events and a reduction in personal donations, funds are scarce. We decide to launch a campaign using patient stories and the impact our service has had – reducing hospital referrals and empowering primary care in remote areas.
Profile: Dr Daniel Grace
Based in South Wales and providing remote care to Zambia
Locum GP, medical director of The Virtual Doctors, and expedition and event doctor